DEP/DUA/1/25/11 (Normalised version)

Andrew Reid

(1780-1781)

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Andrew Reid.

Of case of this patient do not reckon is necessary to offer many observations.

And that both as affection very similar to one lately treated & as has been but little subject of practice here

While at same time do not know what has been event of case.

Disease a very distinctly marked instance of Icterus or Jaundice.

And here equally certain evidence of presence of bile in blood & of absence in alimentary canal.

First indicated not more certainly by yellow colour than by deep tinge to urine.

Jaundice indeed may take place where latter symptom does not exist.

For though bile present in blood yet state of urinary organs may be such that cannot in this way have free exit.

From absence therefore cannot infer that jaundice not present.

Yet when does occur even less [equivalent] mark of presence of bile in blood than yellow colour

For this in consequence of change in [serum] may happen even independently of bile

And is probably on this principle that to account for tinge, in chlorosis yellow fever & like.

But in instance before us, even if urine not affected, no such cause could here be suspected.

And should have considered yellow colour alone as sufficient evidence of introduction of bile into blood.

In appearance of stools again, evidence of want in alimentary canal.

For although belly not bound [thus] deprived of usual yellow tinge.

Hence then no doubt that considerable if not total obstruction to passage of bile into intestines

Or in other words that disease jaundice.

And in history here introduced, most if not all those appearances, which the common attendants of that affection.

While at same time few occurrences in present case which can be reckoned peculiar – Of these however some claiming attention. And first with [respect] to time of discharge, belly natural.

Bound state of belly, it must be allowed a common symptom in Jaundice.

And indeed a natural consequence of want of that stimulation to peristaltic motion of intestines which bile affords

At the same time, though in general influential, yet not essentially necessary.

And instances may occur where [ingest] or other secretory fluids besides bile which still [poured] into intestines may in this way have full effects.

Such then suppose to be cause, of this singularity if can be called such when [time] [occur]

Another particular which may perhaps be considered as uncommon is frequent [inclination] to discharge urine

This can by no means be represented as a symptom never occurring in Jaundice

At same time not commonly marked in history of the disease.

But perhaps rather [surprising] as others, that does not more frequently occur.

Particularly in those cases where urine obtains very deep tinge.

For then no doubt that a peculiar matter impregnating urine to be thrown off.

And from sensible qualities in alimentary canal, may conclude that here also stimulating power.

Hence then perhaps greater difficulty to explain why should ever be watery, than why sometimes occurs.

In every instance however must be much affected by state of sensibility.

And from more than common sensibility are probably to account for occurrence to uncommon degree in present instance.

If in these however what to be considered in any degree as peculiar one still more striking in mode of attack

Affection we are told commenced after severe attack of universal Rheumatism.

And was immediate consequence of Rheumatic pains suddenly ceasing.

If these circumstances in any degree connected as cause & effect, must be allowed very great singularity.

But no reason to conclude that this is the case.

And while one set of circumstances may have given rise to cure of Rheumatism, another may have induced Jaundice.

And this the rather probable, as very difficult to conceive how cure of Rheumatism, & cause of obstruction to bilious ducts, can be considered as in any degree connected.

These then only peculiarities if can be called such, which deserve notice.

And upon whole, while pronounce case instance of Jaundice, may at same time say that without any very uncommon occurrence.

To apply this observation to prognosis would lead us to entertain favourable hopes.

For at least in greater number of instances disease removed without much difficulty.

And as in case last treated here also I think reason to presume that depended on calculus.

A circumstance which if not cause of very slightest instances of Jaundice is at least seldom origin of incurable cases.

Hoped therefore that by proper treatment should soon have favourable termination

Such an event there is some reason to presume has already taken place.

At least when patient last visited us, appearance such as favours this supposition

But as has not of late attended no opportunity of knowing for certain conclusion.

During attendance plan pronounced same as in former case

Repeated emetics directed with view to concussion.

By this hoped that calculus [might] be discharged & radical cure of affection obtained.

Here indeed cathartic not indicated as means of obviating costiveness.

But imagined that means of still farther gently moving belly, might be proper.

Particularly as tending to discharge of calculus if should make way from biliary duct into intestinal canal.

At first report after these medicines directed, appearances as already observed very favourable.

For not only mitigation of symptoms but such change on colour of stools as gave reason to hope that obstruction already removed.

Perhaps therefore in reality no farther measures necessary.

But still consider it as most advantageous plan, to repeat emetics & continue pills.

And hoped that at subsequent report still more convincing evidence of cure.

But as have not since seen patient cannot speak with confidence as to termination of case.

At same time some grounds for presuming that patients desertion has proceeded from having no farther occasion for assistance.